Beauty and The Breast (a blog that later went offline) blogged on my Silicone Implant Position Post. They placed a picture of a Saline-filled implant explantation specimen with what appeared to be thick capsules seemingly to say “see this happens with saline implants too.” The capsule pictures they showed were kinda low resolution but did not seem to have calcium deposits.

Maybe I need to clarify this a bit. The process of capsular contracture happens with all foreign bodies placed into the body. The body makes a capsule with all breast implants silicone and saline. The question when such a device is placed is not whether it will occur but how can we make it occur to the least extent.

Things that can make capsules worse (generally thicker) include:

(1) Bleeding and/or Trauma

(2) Smoking

(3) Poor or Thin Soft Tissue Coverage

(4) Infection

(5) Radiation therapy

and arguably Silicone Gel.

Now why the Silicone Gel:

First by “Gel” we mean the stuff in the implant container or “shell.” The hard silicone gel “shell” that holds the contents of all breast implants is the same as the cover of other implants such as pacemakers etc. This alone has never been shown to be associated with thick capsules without one of the other things we mentioned above going on as well. When those capsules get thick, they rarely get calcified. This is relative to the “shell’s” solid silicone alone.

Silicone Gel is a non-biological filler put in the “shell” in Silicone Gel implants. It unfortunately does not stay in its container well. When you put Silicone Gel into the “shell,” we find that it weeps right through this “shell” in a process called Silicone Gel “bleed.” This is not the same with Saline-filled and Silicone Gel implants.

It is my belief that this added gel bleed contributes not only to thick capsules, but to the development of calcium deposits that make silicone gel implant capsules harder than any Saline-filled implant capsule. Those are the “glistening white shards” you see in the video from my previous post. So you can get thick capsules with any implant if other things happen, but the calcium deposition seems to be much more of a problem when you add the Silicone Gel. And this makes really hard; uncomfortably hard capsules.

The problem with these observations is that some women have had both Saline-filled and Silicone Gel implants. You never really get all the gel out of there when you remove a pair of implants. The gel as we mentioned weeps into the breast tissue as well. You get most of it out by removing the capsules with the implant. So there are cases of women who have had both types of implants having capsules. It kinda blurs the margin between the two when you are trying to keep track.

I appreciate the gals at Beauty and The Breast posting on this as it showed me that further discussion was needed. Again I am not saying Silicone Gel implants are “bad” and Saline-filled implants are “good.” I am saying that the severity of the local tissue reactions that develop with breast implants tend to be less over time with Saline-filled rather than Silicone Gel implants. This has been the summation of my experience working with them over the last 13 years. When a woman chooses to have breast implants she has to make a choice. This choice has something to do with risk tolerance. If women choose Silicone knowing this, that is of course their choice. I am mostly a Saline-filled breast implant surgeon although I do place some Silicone Gel implants as well.

Best Regards,

John Di Saia MD

Originally posted 2008-06-30 07:30:00.